I drove to Hopkins after practice on Wed for my last ultrasound checkup. Things are about the same, starting to grow collaterals, but that process takes years. Dr Lum was somewhat astonished that I could still pull off a #1 ranking with completely occluded veins. I told him the only thing that saves me is my SDK. He's not very bullish on the long term success rate of vein bypass surgery and I am loathe to have more major surgery. So I trudge on growing collaterals.

I had my follow up at Hopkins and the news was not good. The extensive clot is still there and the axillary and subclavian veins have re-closed since the balloon venoplasty. I suspect the re-closing was what I perceived as a strain in the thoracic area a few weeks ago. Vein reconstruction surgery is not a good option because it would require a bypass with only a 50% or less chance of success. So I need to grow some collateral veins; I may already have some since my arm is not all that swollen. But there is some fear for my left side, which is showing some pre-thrombolytic symptoms.

I will have another ultrasound on both sides in 2 months. If the left side is showing more signs of damage than last time, I may have another first rib resection at that time. That surgery may have a better likelihood of success than the one in December if we avoid a clot. Or I could just use a conservative approach ... The downside of that is that I think I would have anxiety over getting another clot/ruining another vein. And I really couldn't swim without compressing the vein further. Streamlining is ultra compressive. And of course my sister had bilateral VTOS.

I have been in the water some. But just kicking with my arms at my side is not very inspiring. My dr said that I could start some swimming, but I am leery about my left arm. I have been on the treadmill regularly; did 14 miles the other day after the bad news. So I am going to put all thoughts of competing aside for now. I may pop into the pool to see friends from time to time. But I am basically retired right now. Maybe next year I can re-assess. Without the primary veins on the right side, it is unclear whether I could ever return to my previous form.

On a happier note, I have a trip to Paris and environs planned in April. And I had a really kick ass 2016 before the VTOS reared its ugly head in October. The Fina rankings have come out and, in the 55-59 age group, I ended up with:

Last time I checked in, I had just had my VTOS surgery (Dec. 8) wherein Dr. Lum removed a huge chunk from my chest. I seemed to recover from that fairly well and did not become a pillbilly. On December 20, I went back to Hopkins for a venogram to check the vein. Disappointingly, but not totally unexpectedly, it was still damaged, compressed and the clot was still there. So I had an angioplasty where they put in 4 balloons to open the vein. Good grief, that really hurt. Not great news, but at least he was able to open the vein. I was told that the second operation had a 70% chance of success; veins that have long been compressed are prone to re-collapse. I survived xmas, but on December 29, I was struck down with an extremely severe case of the flu, which developed into bronchitis. I was really sick for 3.5 weeks -- the sickest I've ever been in my life. I only made it to one PT appt, then had to cancel all the rest. At this juncture, I've decided that I'm not going to bother with PT. I had full ROM almost immediately in any event. My arm is still somewhat swollen, but down from before. I was given a 3-6 month estimate for it to return to normal. My next appt is on March 23 and they will again check the vein with a duplex ultrasound. If there is still damage/clotting, I will need vein reconstruction surgery. I also struggled a bit with the oral blood thinner (xarelto). It made me nauseous and tired. So I switched back to lovenox. Downside is injections 2x day. Still, better than nausea.

So Dec & Jan were just a life hijack. After an epic struggle, I have been feeling pretty normal the last 10 days. I can't do anything high impact or anything with my arm. I've been doing a lot of fast walking on the treadmill, between 5-9 miles a day. My incision is healing fine, so I may be able to get back in the water and kick with my arms at my side fairly soon. My dr really errs on the conservative side wrt the pool. But I know others that returned to the pool 6 weeks after VTOS surgery. I may also go to a spin class or some bikram yoga. Vinyasa is out because of all the down dogs.

I had my VTOS surgery on December 8 at Johns Hopkins. The surgery went well. The dr extracted a fairly massive first rib (see attached). The rib was abnormally large and was the culprit of the venous compression. There was also a great deal of muscle surrounding the rib, which was excised. I had a difficult time with the anesthesia, which caused me to throw up a few times. That is not particularly fun after an invasive surgery. I was able to move my arm right away and was on my feet quickly. The drive home was rather painful; I could feel every bump. I have a venogram scheduled for December 20 to assess whether the vein is patent and the clot has dissolved. I hope the vein bounces back from the compression, but the clot was very extensive. Depending on the results, I could be on blood thinners for awhile. I just hope there is not permanent damage. Anyway, the pain is reasonable tolerable with the pain meds. And my daughter is arriving home from college today!

I went to Johns Hopkins last Thursday for some testing and to see Dr. Lum. 9 days earlier, I finally had my chest CT with contrast and it was negative for blood clots. But by the time I got to Hopkins, a duplex ultrasound showed an extensive blood clot from mid chest to mid arm and confirmed a diagnosis of venous thoracic outlet syndrome. So it is a worst case scenario. VTOS is an extremely rare condition, but healthy athletes like swimmers are somewhat more at risk, and I am genetically pre-disposed. I am on blood thinners now and will have to have surgery in a couple weeks. There is no other solution, you have to de-compress the subclavian vein in the thoracic outlet. For the surgery, the resect your first rib and take out the attached scalene muscle. No swimming for 3 months after the surgery. Since I haven't swum much in a month, it is going to be a long time out of the water. And I can't exercise at all right now. My left side is somewhat compressed as well, but Dr Lum thinks the likelihood of VTOS on that side is still low. I worry, though, because my sister had to have bilateral surgeries.

On the upside, a blood clot did not break off and go to my lung or brain. And I've been told that it's possible some of my shoulder and elbow problems on my right side may have been to do maladaptive compensations from inadequate venous return. I have felt like my breath holding capacity has declined somewhat the last couple years. This could be why, and may also be fixed by surgery. Hopefully, there is not too much damage to the vein.

Dr Lum thinks that the culprit may be all my streamline dolphin kicking bc you are in an extremely compressed position when doing that. I did even more kicking that usual this year bc of my elbow and shoulder tendonitis issues. I may have to consider doing less SDK work upon returning.

So I'm signing off for awhile. It will seem odd ... I've been blogging for many years now ... since the creation of the USMS blogs. And I haven't had any real break from swimming in 11 years. The timing is very disappointing, in my age up year. But masters swimming seems to be defined by comebacks. Hopefully, that will be my case.

I took myself and my swollen arm down to the Sprint Classic. I've felt horrible in the water the last couple days. I kind of ignored that thinking that it was stress/sleep related/not swimming much. But I realized after warm up and a couple races (duh) that the lack of circulation was causing fatigue and really driving up my heart rate. I only swam two events, and ended up scratching the battle of the drop dead sprinters. I was too exhausted and my arm was slightly numb. I did set two 55-59 national records in my pet events, although with quite mediocre times for me.

50 fly, 27.0

The start, turn and underwaters were all solid. But I could barely get my arms out of the water the last 2-3 strokes. I know that is not training related. And I only take 13 strokes in a 50 fly. I was so tired afterward that I knew I shouldn't attempt the 100 IM. My fly and free feel the worst right now. Hopefully, I can do a :26 later in the season.

50 back, 28.1

Same story here. My start and underwaters were solid. I did have a bit of a glide into the turn. My turnover lacked some zip, especially the second length. I haven't done any AFAP backstroke since August while getting over bicep tendonitis, so I felt a little rusty. I could not get my heart rate down after this race for a long time. Hopefully, I can knock this time down some more later in the season.

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Later in the evening after I got home, the overall swelling went down and is now localized in the bicep area again. It seems like some kind of lymphedema ....idk ... I had KT tape on before my races. I took it off and was bruised in the entire area, suggesting little circulation. I'm off to get a chest CT scan this am and have a cupping and cryosauna appointment. I had planned on a meet in November. But I'm not going to compete until this clears up. And it looks like I will have to go back to mostly kicking, again.

I was trying to take it a bit easier than usual and do more hypoxic work and less intense work.

Unfortunately, my right bicep hurt during practice. After practice later that night, most of my arm became very swollen. I spent over 5 hours yesterday in the ER getting all sorts of tests done. No blood clot, abscess, tumor, cellulitis, nothing. No clue why it occurred. And it is still swollen. I really hope this is going to go away soon. It's hard to sleep with it as well. Frowny face.

The Council Bluffs pool is a fairly crappy pool. I can live with that in the short term. But the temperature feels like 85-86 and I was roasting. Had to take cold showers afterward.

Been having fun at the trials. The night sessions are incredibly exciting with cool special effects. Today's prelims were a tad dull. The best prelim racing thus far has been in the men's 100 breast. My off the top thoughts from watching:

1. Swimmers who apparently did partial tapers aren't doing that well. This seems to include Franklin. Her starts are always bad, but her first 25 of the 100 back last night seemed sub elite. Why she thought she could do a partial taper after her fairly poor showing last year is beyond me. I wonder if the transition to being a pro swimmer, with all the attendant commitments, was too taxing?

2. The men's 100 breast was impressive. Michael Andrew really showed up. I thought it was odd that Licon scratched the 400 IM for the 100 breast.

3. Murphy and Plummer looked crazy fast in the 100 back semi-final and it appeared that Murphy shut it down a little at the end.

4. Coughlin does not look great. Too bad after her fine year in 2015. Her starts didn't look as dominant as usual either.

5. It will be a dog fight tonight in the men's 200 free. I hope we have more guys under 1:47 though.

6. Beisel was spotted in medical today and the word is that she fractured her finger in warm up. Hope she can at least swim the 200 back bc her backstroke looked amazing in the 400 IM.

7. Dirado, Margalis, Worrell and Smith = amazing.

8. Lochte ... I'm not sure training with SwimMac was great for the 400 IM. And the effort from trying to contest it may tire him for his other events. He should make the team in the 200 free based on recent times, but I have a bad feeling about it. His walls are like a magic trick.

9. I'm really hoping Conger pulls off his double tonight. I'd love to see him on the team.

I ventured to the Lebo pool for adult swim, but the pool was closed for a swim meet. Shut out again! Because of Father's Day, I didn't have time for a long drive to swim elsewhere. So I contented myself with a couple miles on the treadmill and some drylands at home before dinner.

Whew, the long course all out 50s were tough. The one that I did fly seemed interminable.

I was hoping to swim long course again today, but I am stuck at the house waiting for a repairmen who is already quite late. While we were at the beach, there was a power outage. That outage apparently fried our Verizon Fios box because we've had no internet, wifi or TV since Saturday. It's like the stone ages here! I think my only swim option is to go to Bethel Park tonight.

Starting to get excited about going to the Olympic trials with my daughter.

This was my last dryland session until after Canadian Nationals. I kept the weight pretty light and stayed away from any upper body plyos. I went to my chiro afterward to have him work on my shoulder. He thinks it's mostly muscular, but could be verging on low grade tendonitis. I don't feel the dull ache that I did last week, so I'm hopeful I just strained something. It's a bit of a relief to be done with drylands for awhile -- it's the place I'm mostly likely to injure myself!

I'm feeling much better (still coughing tho) so am thinking nationals is a go barring some relapse. I'd really like to attend this year because I probably won't go next year (in Ca, outdoors).

After yesterday's double, I planned a short speed workout for today, and that was definitely all I had the energy for. Still dragging with a lot of chest congestion, and losing my voice. If I feel like crap tomorrow, I'll take the day off. It's been 6 days in a row anyway.

I looked back at my blog from this time last year. Late March-early April, I was suffering from allergies, had an ear infection, had an allergic reaction and was on prednisone. I only swam 2 events at Zones, and my times were terrible. I love spring, but it really hates me. I just hope there is time for my negative reaction to spring to recede. I'm glad that I'm not entered in Zones, though this will be the first time in my masters career that I've missed it. Being sick during a taper is one thing. Being sick on meet day just sucks.

Emboldened by my phoenix like rise from mono in the nick of time for NE Champs, I made the journey to Ohio State for the Huntington meet. I was perhaps overly emboldened, as well as overly obsessed with sticking to my meet plan for the month. I did not feel quite 100%. I tried to compensate for some fatigue with extra caffeine. Then I just felt tired but wired. Still, even though I felt a little off, shutting it down in the pool for the last few days really helped. I swam some very fast in season times -- no doubt due to an assist from a super fast pool. The meet went quickly and clocked in under 3 hours. My events were all swum in about 2 hours.

50 back, 27.43

This event just felt labored the whole way. My legs felt quite tired -- probably from my last hard drylands session. I had decided to try taking 7 strokes the first length instead of 8 (I seem caught between 7 and 8.). This resulted in a major glide into the turn and a poor push off. I feel like that cost me a few tenths. Honestly, I expected to be a good half second slower and was pleasantly surprised when I saw my time. But I felt dead afterward and had a hard time getting my heart rate down.

50 breast, 32.84

I had a very good start and executed fairly well except for my walls. I had to short stroke both walls. Because I don't race breaststroke all that much, I have no idea what my stroke count is or should be. I just know that, in the past, gliding into the walls has killed my momentum. This race felt like a breeze compared to the 50 back. And my time was only .04 off my tapered PR from 2013 nationals. Was stoked with this time, which was .4 faster than my time at the Sprint Classic (where I had good walls). This is only the second time I've been under :33.

100 IM, no swim

There were only 8-9 heats between 50 breast and 100 IM. I just couldn't do it. I felt very tired and went to lay down on my yoga mat for half a hour to reboot. In retrospect, if I had wanted to swim 100 IM, I should have skipped the 50 breast. Not a big deal, and then I had some real rest before 50 fly.

50 fly, 26.06

I popped back in the warm up pool to wake myself up before this race and try to get psyched. I was sitting next to a couple guys who were swimming this event and had seen my 50 back. They said, "it's on!" And, well, who can resist that kind of good natured trash talk? So I got ready to swim fast. This was my best race of the day. I felt like I flew off the blocks. I wish they had reaction times posted. My UWs were good, breakouts were good, finish was good. I just had a slight glide into the first wall after taking 5 strokes, but nothing major. Was extremely happy with the time, which was again .4 faster than my time at the Sprint Classic (a meet for which I was more rested). This race felt much better than my 50 back. I'm not sure why that first race felt so awful.

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Very glad that I made the effort to race at the meet and happy with my times. 50s require a lot of racing to fine tune. I think these are all my best "in season" times. Of course now I'm wondering how many tenths can be attributed to the fin? Haha. I feel more tired from this meet than I was after Albatross. I hope I can shake off this fatigue soon. Off to the gym.

Feeling a little better today. Got in a solid gym session and short swim afterwards. I'm definitely stronger after an extended period of consistent lifting. The 275 on leg press didn't even seem that hard. I'm trying to figure out when to stop lifting before USMS nationals with Canadian Nationals just 3 weeks after ... It seems like I would really start losing strength at 4 weeks off ... Off to ice the elbows.

I am super excited that I persuaded Jim and Bill to go to nationals. Bill is going to join RAM as well. With Water Rat, there will actually be a Pittsburgh presence! And a fun carpool down!

I took yesterday off, felt wretched. Rallied a bit today, but still low energy. Did not feel up to a USRPT set. I will have very few swimming options the next few days. The pools are all closed for spring break etc. On the upside, my elbows are feeling better. Not 100% but getting there.

I'm looking forward to watching NCAAs. Big shocker in the 500 free with Smith not making finals. I hope he's just sick and not a head case like some commenters think.

I don't mind doing breaststroke, but that was a ton of it. I needed that backstroke interlude in the middle. Bill says my breaststroke kick is improving. He told me to keep my feet behind hips, so that's what I've been focusing on. I feel pretty tired this am from that workout. It did have a fair amount of race pace work in it. I'm heading to Sewy later to meet up with Water Rat for a workout.

8 x (25 AFAP + 75 EZ) @ 3:00-3:30
-- the pool was packed and I was splitting a lane so I opted for
-- 2 breast, 6 flutter kick (no fins)
-- I couldn't see my times bc the clocks were not synched
-- my flutter kick is much worse than my dolphin kick, so probably should work on it more
100 EZ

Jim & Bill arrived at this point, so I swam one set with them and then went back to sprinty things.

It was a mob scene at the pool yesterday. There were only three lanes for lap swim with 50+ kids in the other three lanes -- my worst nightmare. But I managed to split a lane or share with Jim & Bill for the most part. I'm pretty tired from that effort so will pass on the pool mob scene today.

I failed at staying up until midnight last night, despite a gaggle of loud girls at our house for a sleepover. Mr. Fort and I re-watched the two latest Star Trek movies to continue our debate over which series is better -- Star Wars or Star Trek.

Then we did Jim's new set:
6 x AFAP kick for :30 + 50 EZ @ 4:30
-- I did these dolphin kick w/fins & board. Was getting to about the 60 yard mark on each :30 effort
100 EZ

Total: 2400

~~~~~~~~~~~~~~~~~~~~~~~~

I felt rather awful in the pool today -- maybe a combination of xmas hangover and a lot of drylands. Jim is obsessed with this new set -- 6 x :30 AFAP kick @ 4:30 based on a recent Swedish study. The set is designed to increase endurance, despite the ample rest. The theory goes something like: the free radicals from all out efforts create calcium leaking in the cell channels, which in turn prompts oxygenating mitochondria growth. I had to poke a little fun at him bc I've been doing a variation of that set (5 x 50 AFAP @ 5:00 for years), and have told him that anaerobic work produces aerobic conditioning effects. But this is the first time he's ever done such a set with me. We were theorizing that there might be some benefit from just pulling such a set too.

My workout options are pretty limited for the next week plus with the high school pools closed, so I may have to go to Sewy quite a bit. There is a Pitt practice tomorrow at 3:00 that I can get to. Hopefully, there will be come later in the week as well. (I refuse to go to the 8:00 am practice.)

Despite sleeping a lot the last couple nights, I still feel pretty tired. Tired but wired. I guess that's par for the course for a multi-day meet. I did get back to the gym for a very light ease back in kind of workout. Inspired by swimdoc, going forward, I may try to add some dedicated TRX core work on off days from the gym. But not today. Still too bushed. Though I will head out to Pitt tonight. I am anxious to get back to real training. I feel like I gained ten pounds from my couch sojourn!

I was bummed to wake up to a crashed over xmas tree with tons of smashed ornaments. Argh! Must have been the damn cat.

But the good news is that, thanks to Stewart's emails, the meet directors did find our time from the mixed 200 free relay and added it to the results.